Medicaid Program Advisor



Found in: Talent US Sponsored – 4 hours ago

Albany, United States Public Consulting Group Full time

Medicaid Program Advisor – Fiscal Analysis in Albany, NY


Staffing Solutions Organization LLC (SSO), a wholly owned subsidiary of Public Consulting Group, is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve.


This individual will assist the Department of Health’s Office of Health Insurance Programs (OHIP) Division of Health Plan Contracting and Oversight (DHPCO) with the oversight of the fiscal solvency of the Managed Long Term Care plans. The incumbent will be responsible for the development, analysis and oversight associated with the Medicaid Managed Care Operating Cost Reports for 30 Managed Long Term Care Partial (MLTC) Plans, 9 Programs of All Inclusive Care for Elderly ( PACE) Plans, 8 Medicaid Advantage (MA) Plans, 9 Medicaid Advantage Plus (MAP) Plans, 34 Medicare Advantage Plans and 1 Fully Integrated Dual Advantage for Individuals with Developmental Disability ( FIDA-IDD) Plan. Additionally, the incumbent will also perform review and analysis of the Medical Loss Ratio and monitor overall plan solvency for the above listed lines of business.

Specific duties include:

  • Assist in the development of quarterly financial reports to collect financial information from the Medicaid Managed Care Organizations (MCOs) in NY inclusive of Medical Loss Ratio reporting and oversight
  • Review and oversee timely filing and accuracy of all MCOs financial reporting (MLTC and Mainstream Plans)
  • Conduct reviews of MCOs financial reporting and operating status, including compliance with Public Health Law, regulations and policies as well as the federal regulations
  • Communicate findings and collaborate with MCOs to improve accuracy of financial reporting
  • Attend and lead meetings with MCO’s to discuss fiscal issues and develop plan of resolution
  • Review and Evaluate plan Solvency
  • Review and evaluate MCO expansions, mergers and acquisitions for MLTC and Mainstream plans.
  • Assist in automating and standardizing financial reports for analysis of fiscal status of the MCO
  • Develop ad-hoc financial reports extracting data, as necessary.
  • Review and evaluate MCO provider and management contracts for compliance with the financial standards and requirements in PHL
  • Expect to supervise 1-2 staff as unit grows.
  • Hold meetings with staff, assign work and oversee the completions of assignments in an effective and efficient manner.
  • Complete performance evaluations for assigned staff.
  • Other duties as may be required.


Basic Qualifications:

  • Bachelor’s degree in business, finance or related field. 
  • Eight (8) years of work history in finance or healthcare. 

Desired Characteristics:

  • Strong Excel and data analytics skills. 
  • Strong communication skills (written and oral).
  • Ability to present data to parties with varying backgrounds.
  • Ability to work independently.
  • Must be a United States Citizen or a Permanent Resident of the United States in order to be considered.


*Employees must follow established work schedules. The usual work schedule is 40 hours per week, Monday through Friday. Normal work hours are 8:00 a.m. to 4:30 p.m. unless otherwise specified by the supervisor, this includes a half hour unpaid lunch break. Total work hours must equal 40 hours per week.


All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an e-Verify participant.


Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.


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